Fresh Start Campaign Materials Order Form

Thank you for your interest in the Fresh Start campaign.

Please select the material and quantity you would like to request. Contact us if you have questions or need help: doh.freshstart@alaska.gov

Materials are available only in Alaska.

Question Title

* Contact Information

First name *

Last name

Organization name

Email Address *

Phone Number

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* Shipping Address

Address

Address 2

City/Town

ZIP/Postal Code

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* 11" X 17" Poster

Enter Quantity

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* 4"X9" Rack card

Enter Quantity

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* 8.5" X 11" One-sheet

Enter Quantity

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* Tear-away 2"x3.5" cards (stacks of 50)

Enter Quantity of Stacks

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* Dementia Brochure

Enter Quantity

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* 8.5" X 11" Dementia One-sheet

Enter Quantity

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* Special delivery requests:

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* How did you hear about the Fresh Start campaign?

Other (please specify)

Fresh Start Campaign Materials Order Form

Question Title

* Contact Information

Question Title

* Shipping Address

Question Title

* 11" X 17" PosterEnter Quantity

Question Title

* 4"X9" Rack cardEnter Quantity

Question Title

* 8.5" X 11" One-sheetEnter Quantity

Question Title

* Tear-away 2"x3.5" cards (stacks of 50) Enter Quantity of Stacks

Question Title

* Dementia BrochureEnter Quantity

Question Title

* 8.5" X 11" Dementia One-sheetEnter Quantity

Question Title

* Special delivery requests:

Question Title

* How did you hear about the Fresh Start campaign?

* 11" X 17" Poster

Enter Quantity

* 4"X9" Rack card

Enter Quantity

* 8.5" X 11" One-sheet

Enter Quantity

* Tear-away 2"x3.5" cards (stacks of 50)

Enter Quantity of Stacks

* Dementia Brochure

Enter Quantity

* 8.5" X 11" Dementia One-sheet

Enter Quantity